Image-guided robots are manipulators that operate based on medical images. These are modern medical tools with applications in most medical fields, allowing the physicians to perform interventions not only under direct vision, but with the additional help of the transcutaneous data. Significant research efforts around the world are dedicated to the development of these systems, and a few are already in commercial stages.
Perhaps the most common class of image-guided robots are the robots for needle interventions; robots that help manipulate needles in procedures such as biopsies, therapeutic injections, thermal ablations, brachytherapy, as part of surgical procedures such as percutaneous kidney stone extraction, etc. Needle robots have been investigated in conjunction with all types of imaging equipment (e.g., x-ray, CT, and most recently with the MRI, such as MrBot [see U.S. Pat. Nos. 7,086,309 and 7,247,116; US. Publication No. 2007/0034046 the teachings of which are incorporated herein by reference and see also Stoianovici D, Song D, Petrisor D, Ursu D, Mazilu D, Muntener M, Schar M, Patriciu A: “MRI Stealth” Robot for Prostate Interventions. Minimally Invasive Therapy & Allied Technologies. 2007; Vol. 16(4) pp. 241-248]. These have the potential to precisely target the disease or the intervention site in a percutaneous, minimally invasive, less traumatic, least disruptive fashion. Unlike humans, robots and imagers are digital devices, allowing for a direct communication and manipulation of the instruments in the image space, while being coordinated and supervised by the physician.
If a point is identified in the images, for example, some of these robots (e.g., RCM—U.S. Pat. No. 7,021,173, the teachings of which are incorporated herein by reference; and AcuBot [see Stoianovici D, Cleary K, Patriciu A, Mazilu D, Stanimir A, Craciunoiu N, Watson V, Kavoussi L R: AcuBot: A Robot for Radiological Interventions. IEEE Transactions on Robotics and Automation. October 2003; Vol. 19(5) pp. 926-930] can orient the needle so that it points at the corresponding location in the patient. Most needle robots position and/or orient a needle guide and the needle insertion is than performed manually by the physician by inserting the needle through the guide. A few systems include automated means of inserting the needle using needle drivers (e.g., U.S. Pat. No. 6,400,979, the teachings of which are incorporated herein by reference).
There are simplicity advantages in manually inserting the needle through a guide. These include, for example, keeping the physician in direct control of the needle, and perhaps allowing for simpler regulatory approvals in using these image-guided systems in clinical trails and practice. However, manual insertion of the needle is a compromise which reduces the utility of a fully automated system. Depending on the application this may be controversial, but they are numerous situations when needle drivers would be preferable. For example, when x-ray based imagers are used, manual insertion would require the hands of the physician to be in the field of the x-rays. Thus, the physician can quickly accumulate exposure with the numerous procedures done on a daily basis.
Also, to reach inside CT scanners, the physician would need to stretch over the patient, and this could inadvertently change the trajectory of the needle while it is being inserted. In addition, inside closed bore MRI scanners it is not feasible to reach in by hand because these MRI scanners are typically narrow long tunnels. In any case, a manual needle insertion can lead to the possibility of insertion depth errors.
Further, needle insertion is a translation movement and translation stages typically are physically larger than their stroke. Also, linear motion is typically implemented using a translational joint. Additionally, there are a few needle drivers available commonly that hold the needle by its head. This is disadvantageous because it maximizes the unsupported length of the needle, reducing its lateral stiffness.
There is found in U.S. Pat. No. 7,297,142, a system and associated method for delivering a selected one of a plurality of instruments to an internal body site. An instrument storage chamber is providing having passages for separately accommodating a plurality of instruments. An outlet guide tube couples from the instrument storage chamber and receives a selected one of these instruments for delivery to an internal operative site. An indexing mechanism is provided associated with the chamber for causing relative displacement between the instruments and the outlet guide tube. An instrument driver displaces the registered instrument from the chamber into the outlet guide tube for delivery to the internal operative site.
There is found in U.S. Pat. No. 6,626,848, devices and methods to reduce the insertion force of a medical needle using reciprocal rotation motion about the longitudinal axis. The device converts continuous rotational motion to reciprocal rotational motion for the beveled needle. A needle using reciprocal rotational motion creates a slit in the tissue, sufficient in size to equal the maximum circumference of the needle prior to insertion of the needle. The insertion force will decrease as the speed of the reciprocal rotational motion increases until a steady state insertion force is achieved.
It thus would be desirable to provide a new device and methods for driving a medical instrument such as a needle into tissue(s). It would be particularly desirable to provide such a device and method that would utilize rotational movement in conjunction with translation movement of the needle to facilitate entry of the driven medical instrument into the tissue(s) to the desired location. It also would be desirable to provide such a device and methods including a translational driving mechanism that can be used in confined spaces such as when using MRI scanners and CT scanners as compared to prior art needle driving devices and related methods. Such needle driving devices and methods preferably would be simple in construction and less costly than prior art devices and such methods would not require users more skilled than those using conventional devices and methods.